Report ,nJv2017-0t3?
Bend Office (541) 330-9155
Geotechnical Office (503) 601-8250
Carlson Testing, Inc. 541 345- 289
Eugene
em Office (03) 589-1252
Tigard Office (503) 684-3460
Daily Report of Proprietary Anchors
Client: BRAD YOUNG
Project: RESIDENCE @ 10025 SW JOHNSON ST CTI Job#: T1702234.
Address: 10025 SW JOHNSON ST TIGARD OR Jurisdiction: TIGARD
CTI representative J. WEMPLE OBOA 1078/WABO SI 02127
was on site this date Jul. 25, 2017 to perform Special Inspection for:
Permit MST2017-00032
DFS #(s) PO Number:
SCOPE OF INSPECTION Location of proprietary anchors inspected [to include grid
lines, elevations (floors) and drawing details]:
1. Checked in with superintendent or client representative.
Name: JOSH ON SITE TO OBSERVE, VERIFY AND INSPECT
Com an JOSH JONES INSTALLATION OF THE FOLLOWING ANCHOR SYSTEMS:
P y
INSTALLATION OF 5/8" THREADED ROD TO 14" MINIMUM
2. Inspection was "IBC" x Continuous n Periodic EMBEDMENT AT (2) LOCATIONS, 20" MINIMUM
EMBEDMENT AT (2) LOCATIONS AND 11" MINIMUM
PROPRIETARY ANCHORS EMBEDMENT AT (7) LOCATIONS USING SIMPSON SET-XP
YesNoN/A EPDXY ADHESIVE AT HDU2 LOCATIONS AT FOUNDATION
1. Reviewed previous inspection reports? LEVEL.
X SEE DWG: 2/S3.1 & 1/S3.2
2. Reviewed evaluation report? X
Verified following items meet manufacturer's
published installation instructions. REPORT SUMMARY
3. Verified minimum embedment depth of the
anchors. x 1. Work inspected was: n Completed n In progress
4.Verified installation of the anchors. x 2. Completed work inspected was in compliance with
5. Verified anchor diameter. x
6. Verified steel grade. 7( Approved plans and specifications I I Shop drawings
X I I RFI I I Design change I I Submittal I I N/A
7. Verified hole diameter.
8. Verified type of drill bit used. x Document #(s) SEE NARRATIVE Dated: NARRATIVE
9. Verified hole cleaning method. x 3. Noncompliance item(s) were noted this date, details on
10. Verified adhesive application. X following page(s). Yes No IT N/A
11. Verified edge distance. x
12. Verified spacing. X 4. Noncompliance item(s) were reinspected this date, details
on following page(s). In Yes n No
13. Verified installation torque. x X N/A
Conform El Remain in progress
Evaluation report number & date:
ESR 2508 Report(s) fmdings were discussed and left with
07/2018 JOSH
of JOSH JONES
Name of product being installed SIMPSON SET XP EPDXY ADHESIVE
Batch Number 095Z146Z 159Z412Z 239X492X
Expiration Date 04/12/18 05/07/18 12/09/17
Based on the Code, approval is required from the Building Official before the SPECIAL INSPECTED items noted above can
be covered. Carlson Testing has no authority to direct work of contractors or subcontractors.
nSee additional report page(s). n Distribute attachments.
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Daily Report of Proprietary Anchors For: 07/25/2017
CTI Job#: T1702234.
Project: RESIDENCE @ 10025 SW JOHNSON ST
Notes:
In some cases more than one box may be checked for a given item on the front page.
Our reports pertain to the material tested/inspected only.Information contained herein is not to be reproduced,except in full,
without prior authorization from this office.Under all circumstances,the information contained in this report is provided
subject to all terms and conditions of CTI's General Conditions in effect at the time this report is prepared.No party other
than those to whom CTI has distributed this report shall be entitled to use or rely upon the information contained in this
document.
If there are any further questions regarding this matter,please do not hesitate to contact this office.
Respectfully submitted,
CARLSON TESTING,INC.
Doug Loftesness Reviewed By:Project Manager
Project Manager Review Date:07/26/2017
JW/KH
CC: BRAD YOUNG
CITY OF TIGARD BUILDING DIVISION - WALTER 'CHIP' BARNETT FINAL/NCL ONLY
JOSH JONES CONSTRUCTION - JOSH JONES JOSHJONESCONSTRUCTIONMGMAIL.COM
8430 SW HUNZIKER ST,TIGARD OR-PO BOX 230997,TIGARD OR 97281
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